Sullivan 1998

Methods	Randomised controlled trial.
Participants	Inclusion criteria: aged ≥ 40 years; documented diagnosis of chronic, stable, primary OA of 1 or both knee joints in association with ≥ 4‐month history of symptomatic knee pain occurring during weight‐bearing activities (people with multiple joint involvement, who had undergone major joint surgery, or had a lower joint prosthesis were also eligible); radiographic evidence of primary OA of 1 or both knee joints, as demonstrated by joint‐space narrowing, marginal spur formation or subchondral cyst formation; use of any of the various common, non‐prescription non‐steroidal anti‐inflammatory drugs ≥ 2 days a week; and non‐participation in a regular programme of physical activity at time of enrolment. Exclusion criteria: serious medical conditions for which exercise would be contraindicated, such as unstable angina, significant aortic stenosis, myocardial infarction within the last 3 months or advanced chronic obstructive pulmonary disease; asymptomatic primary OA of 1 or both knees; dementia or inability to give informed consent; non‐ambulation due to amputation, stroke or incapacitating arthritis; or involvement in another treatment programme or study protocol. Country: US. Sample number: IG: 47; CG: 45. Mean age: 72 years. Progress Plus: 75% women; 27% married, 72% unmarried; 96% white American, 3% Hispanic Latino.
Interventions	Provider(s): not stated. Training: yes. Setting: hospital, group based. Content: multicomponent: aerobic + patient education. Length/intensity: 3 sessions a week for 8 weeks. Control: weekly telephone call.
Outcomes	At 12 months: pain (AIMS); self‐efficacy (VAP Self‐Efficacy).
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Random numbers table.
Allocation concealment (selection bias)	High risk	Randomisation conducted by the study co‐ordinator; no mention of concealment.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and providers not blind to treatment allocation.
Blinding of outcome assessment (detection bias) All outcomes	High risk	Unblinded outcomes assessor.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Attrition: IG: 38.2% (18/47); CG: 48.8% (22/45). Lost to follow‐up: IG: 3 refused to be interviewed, 2 sick in the hospital and unable to complete an interview, 1 death 1, 12 could not be contacted; CG: 3 refused to be interviewed, 2 death, 17 could not be contacted. ITT analysis.
Selective reporting (reporting bias)	Low risk	All outcomes reported.
Other bias	Low risk	No other bias detected.